title: Cardiac effects of echinocandin preparations - three case reports.
abstract: OBJECTIVE
  Echinocandins are antifungal agents, routinely used in invasive candida infections in critically ill patients. Their excellent anticandidal activity and their low frequency of reported adverse events and drug interactions make them first-line guideline treatments of candidiasis especially in intensive care units (ICU). We report on three ICU patients who developed cardiac insufficiency and hemodynamic instability during administration of loading doses of an echinocandin.
  
  
  METHODS
  Three ICU patients showed a substantial drop in their cardiac index or a deterioration of the mean arterial pressure following start of echinocandin administration. The patients were 75 years (female), 71 years (male) and 66 years (male) old. One patient received caspofungin, and two patients received anidulafungin as empirical antifungal treatment for severe sepsis.
  
  
  CONCLUSIONS
  Our cases suggest that the observed cardiac impairment could be associated with echinocandin administration. Therefore, we recommend close hemodynamic monitoring of critically ill patients receiving echinocandins.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University Hospital of Giessen and Marburg, Giessen, Germany. christoph.lichtenstern@chiru.med.uni-giessen.de
authors.forename: C
authors.initials: C
authors.lastname: Lichtenstern
authors.forename: M
authors.initials: M
authors.lastname: Wolff
authors.forename: C
authors.initials: C
authors.lastname: Arens
authors.forename: F
authors.initials: F
authors.lastname: Klie
authors.forename: R W
authors.initials: RW
authors.lastname: Majeed
authors.forename: M
authors.initials: M
authors.lastname: Henrich
authors.forename: F
authors.initials: F
authors.lastname: Uhle
authors.forename: S
authors.initials: S
authors.lastname: Weiterer
authors.forename: R
authors.initials: R
authors.lastname: Röhrig
authors.forename: M A
authors.initials: MA
authors.lastname: Weigand
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000009:adverse effects*; D054714:Echinocandins / Q000009:adverse effects*; D005260:Female; D006331:Heart Diseases / Q000139:chemically induced*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins
keywords: antifungal therapy; echinocandins; organ failure; sepsis; shock